Lots of hand-wringing over how doctors wash up

Studies show it’s hard to get doctors to properly follow handwashing protocols. (Fotolia)

A few years ago, Cedars-Sinai Hospital in Los Angeles took a unique approach to shaming doctors — found to be the least compliant with handwashing protocols — into taking the infection control method seriously.

Those observed washing their hands were handed $10 Starbucks gift certificates, while others had their hands dipped into Petri dishes to see what bacteria were lurking on their unclean palms. Photographs of the "gobs of colonies of bacteria," as the New York Times called it, were then sent around the hospital as screensavers to remind staff of what lurked close at hand.

There’s no indication that Cape Breton Regional Hospital plans to adopt similar strategies to expose handwashing scofflaws, but some of its physicians appear to be upholding the tradition of ignoring the most basic of infection control protocols.

A recent audit of the facility, done in response to a couple of serious outbreaks of the bacterial infection

C. difficile, found doctors to be the least likely to wash their hands.

The head of the province’s infection control centre said Friday there are hygiene issues among all groups in a hospital, but admitted doctors are often hardest to get on board with basic handwashing.

"Physicians are a tricky bunch," said Suzanne Rhodenizer-Rose. "I’m not sure why we tend to have so much trouble getting buy-in at the physician level."

She said doctors may feel they don’t need to scrub up between patients when they’re not physically touching them. But she said items in a room can also be contaminated, especially with something as virulent as

C. difficile.

Rhodenizer-Rose said the proper routine is for a doctor to wash up when entering a patient’s room and before leaving.

She said she once worked in a district that encouraged patients to speak up when a health-care provider did not wash up before an examination but few were bold enough to do it.

"It really didn’t take off because patients don’t feel that empowered to make those types of requests," she said. "In theory it’s a great approach, but it doesn’t happen that way."

Dr. Lynn Johnston, the head of infectious diseases at Dalhousie University and the Queen Elizabeth II Health Sciences Centre, said Capital Health has worked hard to educate doctors and others about the importance of proper hand hygiene.

She said no doctor wants to intentionally spread infection, but some may not have realized they were breaking the protocol. Other times, it may have been difficult to follow it.

She said the Halifax medical centre has taken pains to make hand hygiene easier by ensuring sanitizers and sinks are close at hand.

"As physicians might have done more poorly in the past, they’re actually coming more up to the mark now," she said. "Our experience here at Capital (Health) is that while they may not be leading the pack, they’re not at the bottom of the pack. We are making progress."

The issue of getting medical staff, particularly doctors, to do something as simple as washing their hands is not new.

In the mid-1800s, Viennese physician Ignaz Semmelweis noted that the mortality rate in a maternity clinic staffed by doctors who were also dealing with cadavers was three times higher than one run by midwives, a statistic that was reversed when doctors began to sterilize their hands.

In 1996, the Australian Journal of Medicine published a study by James Tibballs on handwashing among medical personnel at an intensive care unit at a Melbourne children’s hospital.

The study noted that compliance among all staff was poor, but worst of all were doctors, who self-reported washing their hands 73 per cent of the time. But the figure fell to nine per cent when anonymous snoops were sent into the facility.

Many years later, the Cape Breton findings were also not great.

When all hospital staff knew they were being watched, compliance ranged from 56 to 100 per cent. When unknown infection control staff was watching, the rate dropped to 60 per cent across all categories, with the worst of the bunch being doctors.

Cape Breton Regional Hospital has also made changes to encourage better hygiene, including installing more sinks in rooms and making boxes of gloves more readily available.

Although doctors may not have the best track record, Rhodenizer-Rose said the province and health authorities take a global approach to infection control and don’t target any one group.

"We always use the same mantra time and time again: disease control is everyone’s business," she said. "When we roll out education or compliance auditing we try to address health-care professionals as a whole."